1. Presentation title SUB TITLE HERE How to Measure Temperature Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford RN, MSN

2. Temperature Techniques & Methods: An Overview Temperatures can be different depending on  Type of Thermometer  Glass or Chemical Dots  Electronic or Tympanic  Body Site  Oral, Axillary, Rectal, Ear

3. Type of Thermometer - Glass Once viewed as the “Gold Standard” Must be left in for several minutes  Up to 7 minutes for an accurate temperature! Now associated with adverse events  Rectal or oral trauma  Breakable  Mercury exposure

4. Type of Thermometer – Chemical Dots Single use Disposable & inexpensive Axillary, Rectal, Oral Can be difficult to read Long measurement time needed  Up to 7 minutes for an accurate temperature!

5. Axillary Temperature Safe & inexpensive Often inaccurate because:  Long measurement time needed  Patient must be still  Patient must be positioned or held Not recommended for young children Must document as an axillary temp and NOT an oral temp

6. Rectal Temperature Thought to be as accurate as an oral temp Needs lubrication Long measurement time needed May cause rectal trauma & cannot be used with:  Newborns  Diarrhea  Rectal surgery or bleeding Patient may be embarrassed Patient must be positioned or held Must document as a rectal temp

7. Oral Temperature Comfortable & easy, no positioning needed Accurate temps when proper technique used  Must place thermometer tip in left or right mouth pocket under tongue  IS influenced by hot & cold fluids  NOT influenced by breathing

8. Oral Temperature Long measurement time Should not be used with:  Confused or uncooperative patients  Infants & small children  Oral surgery or oral trauma  History of seizures or chills

9. Temperature Technology Automated Temperature Machines  Electronic and infrared thermometers  Convenient  May save time & labor

10. Ear (Tympanic) Temperatures Easy site to use with accurate temps Rapid measurement – 2 to 5 seconds! Uses disposable, single use probes No interference with breathing Little patient positioning needed Not effected by food, drink, or smoking Can be used with all age groups & most patients  Newborns (no heat loss), infants & small children  Useful with confused & uncooperative patients

11. Ear (Tympanic) Temperatures Can be affected by heat & cold:  Heating & cooling measures  Hot packs, ice packs, heating blankets  Extreme outside and inside temperatures  Air conditioners, overheated rooms  Very hot or very cold days  Bathing or swimming  May need to wait 20 minutes for accurate temp

12. Ear (Tympanic) Temperatures Can also be affected by:  Impacted ear wax & ear infections  Whether an ear tug is used Should NOT be used if patient had ear surgery

13. Ear (Tympanic) Temperatures What Patients Think About Ear Temperatures  Parents of pediatric patients like them!  Fast, easy, clean, and safe  Pediatric patients react better!  Faster measurement  Can stay in parent’s lap or arms  No holding or restraining  No positioning

14. Terminal Digit Preference Some people may show a preference for certain numbers in temperature readings*  Zeros, even numbers, odd numbers Be aware you might “like” some numbers more than others! (*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007) Temperature – It’s All About The Numbers!

15. Tympanic Temperature Procedure 1.Wash hands & put on gloves if appropriate 2.Assist patient into a comfortable position Head turned to side, away from HCW Pediatric patients can be in parent’s arms or lap

16. Tympanic Temperature Procedure 3. Remove thermometer from handheld unit Slide disposable probe cover over probe tip until locked in place Do not touch lens cover Do not apply pressure to ejection button http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

17. Tympanic Temperature Procedure 4.Use correct ear to measure temperature If holding thermometer in right hand, use right ear If holding thermometer in left hand, use left ear http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

18. Tympanic Temperature Procedure 5. Insert covered thermometer probe into ear canal and position properly Children 1 year & older/Adults: Gently pull top of ear back, up, & out Children less than 1 year: Gently pull top of ear straight back Point tip towards nose Less than 2 yrs: point tip between eyebrows & sideburns Snugly fit probe tip in ear canal and do not move

19. Tympanic Temperature Procedure 6.Depress scan button on handheld unit 7.Leave probe in place until a “beep” is heard Temperature will appear on digital display screen 8.Carefully remove probe from ear canal 9.Push ejection button on handheld unit to remove probe cover Place used probe cover in trash – DO NOT REUSE!

20. Tympanic Temperature Procedure 10.To repeat a temperature measurement: Use a new probe cover Wait 2-3 minutes if using the same ear May use the opposite ear with new probe cover 11.When temperature measurement is done: Return handheld unit to thermometer base Tell patient the temperature reading Assist patient to comfortable position Remove gloves & wash hands

21. Tympanic Temperature Procedure Inform RN or MD if:  Very low or very high temperature  Normal temp: between 97 o to 100 o F  Ear wax is seen in ear or on probe cover  Unable to get a temperature reading due to:  Uncooperative patient  Confused patient  Parent or patient refuses  Machine malfunction

22. Tympanic Temperature Procedure 12. Document the Results  Flowsheet, clinic record, or clinic chart 13. Communicate the Results  RN  MD

23. Temperature Measurement in the Clinic YOU can make the difference:  Welcoming presence  Decrease any anxieties & fears  Reassure patients & family  Accurate vital signs